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Breaking News > Claims Corner

Breaking News - Claims Corner

Recent Billing/ Policy Updates

Attention	Articles	Posting Date
Physicians, Outpatient Hospitals & Clinics	New HIPAA Conversion for Bupivicaine HCL, Chloramphenicol Sodium, Hydroxyzine HCL, Neostipmine Methylsulfate and Pentamidine Injection Codes	May 2012
Oncologists	New Chemotherapeutic Injection Code, Ipilimumb (Yervoy) - J9228	May 2012
Outpatient Hospitals & Clinics	Medi-cal Policy Update for Essure ® System ESS305 (Permanent Birth Control System by Conceptus. Inc.)	May 2012
Obstetricians	Medi-Cal Billing Update for Chorionic Villus Sampling (CPT-4 59015)	May 2012
Physicians	Pain Management CPT Codes 62310 and 62318 - No TAR Required	May 2012
DME Providers	CPAP Supplies - No TAR Required	May 2012
Physicians, Outpatient Hospitals & Clinics	New Medi-Cal Benefit - Brentuximab Vedotin (C9287)	April 2012
Family Planning Providers	Medi-Cal Rate increase for Etonogesterol Implant System	April 2012
Surgeons	Medi-Cal Policy modification for Visits before or On the Day of Surgery	April 2012
Physicians, Outpatient Hospitals & Clinics	Frequency limitations changing for Non-Invasive Vascular Studies Codes 93875-93888 & 93925-93979	April 2012
All Providers	ICD-10 Implementation - DELAYED	April 2012
All Providers	Changes to the NCCI Edit Tables	April 2012
Physicians and Outpatient Hospitals	Removal of TAR for Certain Pain Injections	March 2012
All Providers	STILL USING PAPER TO SUBMIT CLAIMS?	February 2012

On the Horizon

The following notifications have been identified as upcoming changes CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time. If a change listed below, applies to you, please check back for articles posting the effective date and specific billing/policy details related to these changes before billing your claim(s).

Upcoming New Benefits

Attention	Notifications	Posting Date
Physicians	New injection, Centruroides (Scorpion) Immune F (AB)2 (Equine) 1 vial - HCPCS C9288	May 2012
Oncologists	New Medi-Cal Benefits: Injections for Doxorubicin hydrochloride, liposomal; Doxil 10 mg (Q2048) Imported Lipodox 10 mg (Q2049)	May 2012
Radiologists	New Medi-Cal Benefit: Computed Tomographic Angiography - 75635	May 2012
Physicians	New Medi-Cal Benefit: Bupivacaine Liposome 1mg - C9290	May 2012
Oncologists	New Injection, Levoleucovorin Calcium (Fusilev), 0.5mg - HCPCS J0641	April 2012
Oncologists	New Chemotheraphy Benefit - Asparaginase Erwinia Chrysanthemi, HCPCS C9289 (not J3590)	April 2012
Physicians	New Injection for Kidney Transplant Recipients - Belatacept 1 mg - C9286	March 2012
Anesthesiologists	A standard process to be set for billing and reimbursement of mobile office based anesthesia claims	December 2011

Upcoming Policy Changes/Rate Changes

Attention	Notifications	Posting Date
Physicians	Policy Update for Negative Pressure Wound Therapy (NPWT)	May 2012
Audiologists	Policy update to change definition of "wholesale cost" for reimbursement of Hearing Aids	October 2011

Upcoming Diagnosis Restriction Changes

Attention	Notifications	Posting Date

Upcoming Code Conversions

Attention	Notifications	Posting Date
Physicians, Outpatient Hospitals & Clinics	HIPAA Conversion for Medi-Cal Program injections: Chloroprocaine HCL (X5924, X5926, X5928 to J2400) Fluphenazine Decanoate (X6220 to J2680) Naloxone HCL (X6614, X6616 to J2310) Phenobarbital Sodium (X6506, X6757 to J25660) Promethazine HCL (X6236, X6742 to J2250) Cefoxitin Sodium (X5854, X5856 to J0694)	May 2012
Physicians, Outpatient Hospitals & Clinics	Medi-Cal code conversion for some injections currently reimbursed under code J3490: Ranitidine Hydrochloride, 25 mg to J2780 Enoxaparin Sodium, 10 mg to J1650 Metoclopramide HCL, up to 10 mg to J2765 Lorazepam, 2 mg to J2060 Diazepam, up to 5 mg to J3360 Local code X6064 (Diazepam, 5mg/ml) to be terminated	March 2012

Claims Corner Archive